Circular xxx of 2015 - List for Open and Restricted ...

1 1 Circular of 2015: Medical Scheme benefit options for open and Restricted schemes approved for 2016 1. The Council for Medical schemes (CMS) would like to share the status of benefit options in open schemes for the 2016 calendar year. Name of medical scheme Name of benefit option Decision Remark/Comment BESTMED MEDICAL SCHEME PACE 4 APPROVED PACE 3 APPROVED PACE 2 APPROVED PACE 1 APPROVED BEAT 4 APPROVED BEAT 3 BEAT 3 NETWORK APPROVED BEAT 2 BEAT 2 NETWORK APPROVED BEAT 1 BEAT 1 NETWORK APPROVED PULSE 2 APPROVED PULSE 1 APPROVED BONITAS MEDICAL FUND BONCAP APPROVED BONCOMPREHENSIVE APPROVED BONSAVE APPROVED 2 Name of medical scheme Name of benefit option Decision Remark/Comment PRIMARY APPROVED

2 STANDARD APPROVED STANDARD EDO (New) PENDING Awaiting exemption approval from Council BONESSENTIAL APPROVED BONCLASSIC APPROVED BONFIT APPROVED New from 01/01/2016 CAPE MEDICAL PLAN HEALTHPACT PREMIUM APPROVED HEALTHPACT SILVER APPROVED HEALTHPACT SELECT APPROVED COMMUNITY MEDICAL AID SCHEME (COMMED) DELUXE APPROVED STANDARD APPROVED ROOTS APPROVED SHINA APPROVED New from 01/01/2016 COMPCARE WELLNESS MEDICAL SCHEME DYNAMIX DSP NETWORK APPROVED PINNACLE DSP NETWORK APPROVED MUMED DSP NETWORK APPROVED SYMMETRY DSP NETWORK APPROVED AXIS DSP NETWORK APPROVED NETWORX DSP NETWORK APPROVED DISCOVERY HEALTH MEDICAL SCHEME CLASSIC COMPREHENSIVE CLASSIC DELTA COMPREHENSIVE APPROVED CLASSIC CORE CLASSIC DELTA CORE APPROVED CLASSIC PRIORITY APPROVED 3 Name of

3 Medical scheme Name of benefit option Decision Remark/Comment CLASSIC SAVER CLASSIC DELTA SAVER APPROVED COASTAL CORE APPROVED COASTAL SAVER APPROVED ESSENTIAL COMPREHENSIVE ESSENTIAL DELTA COMPREHENSIVE APPROVED ESSENTIAL CORE ESSENTIAL DELTA CORE APPROVED ESSENTIAL PRIORITY APPROVED ESSENTIAL SAVER ESSENTIAL DELTA SAVER APPROVED EXECUTIVE APPROVED KEYCARE CORE APPROVED KEYCARE PLUS APPROVED KEYCARE ACCESS APPROVED CLASSIC COMPREHENSIVE ZERO MSA APPROVED SMART APPROVED New from 01/01/2016 FEDHEALTH MEDICAL SCHEME MAXIMA BASIS APPROVED MAXIMA CORE APPROVED MAXIMA PLUS APPROVED MAXIMA STANDARD MAXIMA STANDARD ELECT (was MAXIMA STANDARD NET)

4 APPROVED Option Name change from 01/01/2016 MAXIMA ENTRYZONE APPROVED MAXIMA EXECUTIVE APPROVED ULTIMA 200 APPROVED ULTIMAX APPROVED BLUE DOOR PLUS APPROVED MAXIMA SAVER APPROVED MAXIMA ENTRYSAVER APPROVED GENESIS MEDICAL SCHEME PRIVATE APPROVED PRIVATE PLUS APPROVED 4 Name of medical scheme Name of benefit option Decision Remark/Comment PRIVATE COMPREHENSIVE APPROVED PRIVATE CHOICE APPROVED HOSMED MEDICAL AID SCHEME PLUS APPROVED ESSENTIAL APPROVED VALUE APPROVED ACCESS APPROVED KEYHEALTH PLATINUM APPROVED GOLD APPROVED SILVER APPROVED EQUILIBRIUM APPROVED ESSENCE APPROVED ORIGIN APPROVED LIBERTY HEALTH MEDICAL SCHEME TRADITIONAL ULTIMATE APPROVED HOSPITAL STANDARD HOSPITAL SELECT APPROVED SAVER STANDARD SAVER SELECT APPROVED COMPLETE PLUS APPROVED HOSPITAL PLUS APPROVED SAVER PLUS APPROVED TRADITIONAL STANDARD APPROVED COMPLETE STANDARD COMPLETE SELECT APPROVED TRADITIONAL BASIC APPROVED MAKOTI MEDICAL SCHEME

5 COMPREHENSIVE APPROVED PRIMARY APPROVED MEDIHELP DIMENSION ELITE APPROVED DIMENSION PRIME 1 APPROVED 5 Name of medical scheme Name of benefit option Decision Remark/Comment DIMENSION PRIME 1 NETWORK DIMENSION PRIME 2 DIMENSION PRIME 2 NETWORK APPROVED DIMENSION PRIME 3 DIMENSION PRIME 3 NETWORK APPROVED MEDIHELP PLUS APPROVED NECESSE APPROVED UNIFY APPROVED MEDIMED MEDICAL SCHEME ALPHA APPROVED MEDISAVE ESSENTIAL APPROVED MEDISAVE - MAX APPROVED MEDISAVE - STANDARD APPROVED MEDSHIELD MEDICAL SCHEME MEDIBONUS APPROVED MEDIPLUS APPROVED MEDIVALUE APPROVED MEDICORE (was CORE PLUS) APPROVED Option Name change from 01/01/2016 PREMIUM PLUS APPROVED MEDISAVER (was STANDARD)

6 APPROVED Option Name change from 01/01/2016 MEDIPHILA APPROVED MOMENTUM HEALTH MEDICAL SCHEME INGWE PRIMARY CARE/STATE HOSPITAL NETWORK PRIMARY CARE/INGWE HOSPITAL NETWORK ACTIVE NETWORK/INGWE ANY OPTION APPROVED CUSTOM APPROVED 6 Name of medical scheme Name of benefit option Decision Remark/Comment STATE/ASSOCIATED HOSPITALS STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC HOSPITALS ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC HOSPITALS ANY GP & PHARM/ANY HOSPITAL INCENTIVE STATE/ASSOCIATED HOSPITALS STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC HOSPITALS ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC HOSPITALS ANY GP & PHARM/ANY HOSPITAL APPROVED EXTENDER STATE/ASSOC HOSPITALS STATE/ANY HOSPITAL ASSOC GP & PHARM/ASSOC HOSPITALS ASSOC GP & PHARM/ANY HOSPITAL ANY GP & PHARM/ASSOC HOSPITALS APPROVED 7 Name of medical scheme Name of benefit option Decision Remark/Comment ANY GP & PHARM/ANY HOSPITAL ACCESS APPROVED SUMMIT APPROVED

7 RESOLUTION HEALTH MEDICAL SCHEME HOSPITAL APPROVED PROGRESSIVE FLEX APPROVED CLASSIC APPROVED SUPREME APPROVED MILLENNIUM APPROVED FOUNDATION APPROVED SELFMED MEDICAL SCHEME MEDXXI APPROVED MED ELITE APPROVED SELFMED 80% APPROVED SELFSURE APPROVED SELFNET APPROVED SIZWE MEDICAL FUND AFFORDABLE CARE OPTION APPROVED FULL CARE OPTION APPROVED PRIMARY CARE OPTION APPROVED SAVINGS CARE OPTION APPROVED GOMOMO CARE OPTION APPROVED SPECTRAMED CYAN APPROVED AZURE APPROVED AQUA APPROVED COBALT APPROVED CAPRI APPROVED SUREMED HEALTH CHALLENGER APPROVED NAVIGATOR APPROVED SHUTTLE APPROVED EXPLORER APPROVED 8 Name of medical scheme Name of benefit option Decision Remark/Comment THEBEMED ENERGY CORE MEDIUM open APPROVED UNIVERSAL APPROVED TOPMED MEDICAL SCHEME TOPMED RAINBOW COMPREHENSIVE APPROVED TOPMED PALADIN COMPREHENSIVE APPROVED TOPMED PROFESSIONAL OPTION APPROVED TOPMED SAVINGS OPTION APPROVED TOPMED ACTIVE SAVER APPROVED TOPMED HOSPITAL

8 PLAN APPROVED TOPMED NETWORK OPTION APPROVED TOPMED LIMITED OPTION APPROVED 9 2. The CMS would like to share the status of benefit options in Restricted schemes for the 2016 calendar year. Name of medical scheme Name of benefit option Decision Remark/Comment AECI MEDICAL AID SOCIETY VALUE OPTION APPROVED COMPREHENSIVE OPTION (was COMPREHENSIVE PLAN) APPROVED ALLIANCE-MIDMED MEDICAL SCHEME ALLIANCE-MIDMED MEDICAL SCHEME APPROVED ANGLO MEDICAL SCHEME MANAGED CARE PLAN APPROVED STANDARD CARE PLAN APPROVED VALUE CARE PLAN APPROVED ANGLOVAAL GROUP MEDICAL SCHEME ANGLOVAAL GROUP MEDICAL SCHEME APPROVED BANKMED BANKMED BASIC PLAN APPROVED BANKMED COMPREHENSIVE PLAN APPROVED BANKMED CORE SAVER PLAN APPROVED BANKMED PLUS PLAN APPROVED BANKMED TRADITIONAL PLAN APPROVED BANKMED PMB PLAN APPROVED BARLOWORLD MEDICAL SCHEME

9 BARLOWORLD MEDICAL SCHEME APPROVED BMW EMPLOYEES MEDICAL AID SOCIETY BMW EMPLOYEES MEDICAL AID SOCIETY APPROVED BP MEDICAL AID SOCIETY BP MEDICAL SOCIETY APPROVED BUILDING &CONSTRUCTION INDUSTRY MEDICAL SCHEME BASIC OPTION APPROVED 10 Name of medical scheme Name of benefit option Decision Remark/Comment CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF) ALLIANCE BENEFIT OPTION APPROVED DOUBLE PLUS BENEFIT OPTION APPROVED FIRST CHOICE BENEFIT OPTION APPROVED VITAL BENEFIT OPTION APPROVED NETWORK CHOICE BENEFIT OPTION APPROVED ESSENTIAL PLUS BENEFIT OPTION APPROVED DE BEERS BENEFIT SOCIETY DE BEERS BENEFIT SOCIETY APPROVED ENGEN MEDICAL BENEFIT FUND ENGEN MEDICAL BENEFIT FUND APPROVED FISHING IN